39J-27758-46375
5 vaccinations
6 coded responses
56 check-ins
5 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 168 / PA
- Registered
- 2020-12-29
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-29
Registered in v-safe
-
2020-12-29
Dose 1 — Moderna
- 2020-12-29
- 2020-12-30
- 2020-12-31
- 2021-01-01
- 2021-01-02
- 2021-01-03
- 2021-01-04
- 2021-01-05
-
2021-01-12
Survey response — day 14, dose 1MedDRA: Lymph node pain, Lymphadenopathy — Feeling: GoodFree text: Shotty lymph node in fossa above right clavicle, tender and swollen for about three days, then resolved. No fever or other symptoms. Vaccine was given in right arm.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-20
- 2021-01-26
-
2021-01-27
Dose 2 — Moderna
- 2021-01-27
-
2021-01-28
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to workAdult check-in
- 2021-01-29
- 2021-01-30
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-10
- 2021-02-17
- 2021-02-24
- 2021-03-03
- 2021-03-10
-
2021-04-28
Survey response — 3 months, dose 2MedDRA: Diverticulitis, Unevaluable event — Feeling: Good · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Diverticulitis responding well to a course of Augmentin. · Healthcare visit (other): CT of abdomenMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-28
Report sent to call center — 3 months, dose 2Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-07-28
-
2021-10-22
Dose 3 — ModernaCo-administered: Flu
-
2021-10-24
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-10-25
Survey response — days 1–6 daily, dose 3MedDRA: Lymph node pain — Feeling: Good · Site: Pain · Muscle or body achesFree text: Tender axilla nodes same sideMedDRA releases: 2024-11 · check-in free text available
- 2021-10-26
- 2021-10-27
- 2021-10-28
- 2021-10-29
- 2021-11-05
- 2021-11-12
-
2021-11-19
Survey response — day 28, dose 3MedDRA: Headache, Oropharyngeal pain — Feeling: Good · Be unable to do your normal daily activitiesFree text: Sore throat and headache with no fever lasting one day.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-27
- 2021-12-03
- 2022-01-21
-
2022-04-08
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-04-14
Dose 4 — Moderna
- 2022-04-18
- 2022-04-19
- 2022-04-20
- 2022-04-21
- 2022-04-28
- 2022-05-05
- 2022-05-12
- 2022-05-19
-
2022-05-26
Survey response — day 42, dose 4MedDRA: Chills, Cough, Headache, Malaise, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Cough, sore throat, fever (101.3° F), headache, malaise, chills. Positive Binax Covid test.MedDRA releases: 2024-11 · check-in free text available
-
2022-05-26
Report sent to call center — day 42, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2022-05-27
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-07-14
-
2022-10-06
Dose 5 — ModernaCo-administered: Flu
- 2022-10-14
- 2022-10-22
- 2022-10-29
- 2022-11-03
- 2022-11-10
- 2022-11-17
-
2023-01-05
Survey response — 3 months, dose 5MedDRA: Benign renal neoplasm, Nephrectomy, Renal oncocytoma — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · HospitalizationMedDRA releases: 2024-11
-
2023-01-05
Report sent to call center — 3 months, dose 5Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prHospitalization · 1 call case(s)
-
2023-01-06
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-04-06
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-29 | Moderna | |
| 2 | 2021-01-27 | Moderna | |
| 3 | 2021-10-22 | Moderna | Flu |
| 4 | 2022-04-14 | Moderna | No |
| 5 | 2022-10-06 | Moderna | Flu |
Call center
3 call center cases
3 successful
Free text
Release 1 — day 14, dose 1
Symptoms: Shotty lymph node in fossa above right clavicle, tender and swollen for about three days, then resolved. No fever or other symptoms. Vaccine was given in right arm.
Release 8 — 3 months, dose 2
Symptoms: Diverticulitis responding well to a course of Augmentin.
Healthcare visit (other): CT of abdomen
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Tender axilla nodes same side
Release 10 — day 28, dose 3
Symptoms: Sore throat and headache with no fever lasting one day.
Release 11 — day 42, dose 4
Symptoms: Cough, sore throat, fever (101.3° F), headache, malaise, chills. Positive Binax Covid test.
Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".
MedDRA terms by release
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| HCVO | Unevaluable event | ✓ | ✓ | ✓ |
| SD | Benign renal neoplasm | · | · | ✓ |
| SD | Chills | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Diverticulitis | ✓ | ✓ | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Lymph node pain | ✓ | ✓ | ✓ |
| SD | Lymphadenopathy | ✓ | ✓ | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Nephrectomy | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Renal oncocytoma | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Lymph node pain | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release